Analysis of the major pathological response influencing factors of neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma
Objective To explore the clinical factors associated with major pathological response(MPR)in esophageal squamous cell carcinoma(ESCC)patients receiving neoadjuvant immunochemotherapy(nICT),and to construct a predic-tive model.Methods We collected clinical data of 205 ESCC patients who received nICT treatment at Shandong Cancer Hospital from October 7,2020 to July 3,2023,and compared the differences between MPR and non-MPR patients.Uni-variate and multivariate logistic regression analysis were used to screen out factors related to MPR,and further construct a nomogram to predict the probability of MPR in ESCC patients after nICT.The C-index,calibration curve,and decision curve analysis(DCA)were used to evaluate the predictive performance and the clinical benefits of the nomogram.Results Totally 102 of 205 ESCC patients achieved MPR.Age(OR=4.374,the 95%CI was 1.989-9.617,P<0.001),sur-gical interval time(OR=13.943,the 95%CI was 3.123-62.240,P=0.001),lymphocyte count(OR=0.115,the 95%CI was 0.046-0.285,P<0.001),monocyte count(OR=17.263,the 95%CI was 1.482-201.154,P=0.023),plate-let count(OR=1.008,the 95%CI was 1.002-1.015,P=0.014),and albumin level(OR=0.799,the95%CIwas 0.702-0.909,P=0.001)were independent influencing factors of whether ESCC patients obtain MPR.The constructed nomogram had a C-index of 0.825,and the calibration curve showed satisfactory consistency between the pre-dicted values of the nomogram and actual values.The decision curve showed the clinical benefits brought by the nomo-gram to patients over an extensive range.Conclusions Age,surgical interval time,lymphocyte count,monocyte count,platelet count,and albumin level are the main factors affecting the MPR of ESCC patients after nICT.A nomogram is es-tablished and validated by using factors associated with MPR to effectively predict whether ESCC patients can obtain MPR after nICT,which can assist clinical doctors in making individualized treatment decisions for patients.